How To Talk About STIs With Your Clients

If you’re going to talk about sex, you probably can’t avoid talking about STIs. STIs will come up as a natural part of discussion of intimate relationships, communication between partners, and negotiations involving new or multiple partners. But how can you handle such a stigmatized topic? Here are the basics that you need to know:

1. There’s always risk.There’s no such thing as “safe sex”, only “safer sex”. Sex with another person is ALWAYS potentially risky. Being safe means reducing risk, not eliminating it. Barriers provide the best protection, but still incomplete protection.Leaving the lights on, looking before touching, and staying alert for sores, bumps, and broken skin is an excellent preventative practice, although it can lead to a rather awkward conversation at a vulnerable moment. If your client is going to reduce their risk meaningfully, they’ll need to handle these kinds of difficult discussions.
2. Some risks are greater than others. Condoms and other barriers provide limited protection, but barriers that are left in the drawer provide none at all. Is your client actually using the protection they have when push comes to shove? Why not? In this conversation, communication issues with their partner(s) may come to the fore.Substance use is one of the riskiest behaviors. Under the influence of alcohol or other intoxicants, people show poor judgment, compromise their values, act impulsively, and sometimes forget it happened.Your client is also at greater risk of getting an STI when they have a new partner, or a partner with a new partner.
3. You can set an example.You don’t have to be an expert on STIs to have a conversation with a client about intimacy, risk, and communication. Keep your eye on the process:
   • What works for them?
   • What are their values?
   • What kind of partner/person do they aspire to be?
   • What degree of risk are they comfortable with?
   • What meaning is made from having a STI, transmitting a STI, discussing STIs?

   Many people find STIs very difficult to discuss honestly, especially when they have something to disclose. You can set an example for your clients by discussing STIs without judgment or shame. This will help model to your clients how to have their own discussions on the topic.

4. Know the basics.Some STIs are caused by bacteria, and are treatable with antibiotics. Some are caused by a virus, and cannot be completely “cured”, but can be treated to varying degrees. Some are caused by parasites, and can be completely cured.Some STIs are transmitted by exchange of body fluids, blood, or feces, and can generally be prevented by taking care with those fluids. Others are transmitted by skin-to-skin contact; barriers may or may not cover the infectious area of skin.It’s not always possible to trace the source of a STI.
   • Many can reside symptom-free in the body, showing symptoms days, weeks, months, or years later.
   • Testing is not 100% accurate for many reasons.
   • Not everyone is honest about or with their sex partners.
5. Always seek accurate, specific information.Information about STIs, transmission, prevention, and treatment changes over time, sometimes drastically. New STIs appear (MGen, anyone?). Never assume your knowledge is up to date. Never assume a non-specializing physician’s knowledge is up to date either. I like to verify facts (and recommend clients do too) using the CDC (Centers for Disease Control and Prevention) and ASHA (American Sexual Health Association) websites.Check out part 2 here for more guidance!